Marsupialization Of Cyst Research Articles

Renal Contraction Therapy by Transcatheter Arterial Embolization for ADPKD - A Modality to Augment CAPD?

ADPKD is an inherited cystic disease, in which the kidney size continues to grow in spite of patient being on dialysis. This leads to some disturbing symptoms that warrant reduction of kidney size. Renal contraction therapy was conventionally been done by laparoscopic or open nephrectomy, cyst marsupialization or cyst decortication. Such procedures were technically demanding and have not yielded satisfactory results. Over the last few decades endovascular procedures have evolved and are now being performed on various vascular beds and for an ever increasing list of indications. The procedure is not technically cumbersome and is minimally invasive. These procedures can be preformed safely even in patients deemed unfit for conventional anaesthesia and surgery. The outcomes are satisfactory with reduced risk of morbidity and mortality. We report 2 cases were transcatheter arterial embolization was done and interestingly one of these patients was benefitted with improved clearance on CAPD.

Congenital dacryocele with large intranasal cyst: efficacy of cruciate marsupialization, adjunctive procedures, and outcomes.

To evaluate the safety and efficacy of a new technique of medial wall cruciate marsupialization of large intranasal cysts associated with dacryocele and to evaluate the outcomes. A prospective, interventional consecutive case series of 7 patients with large intranasal cysts were included in this study. All patients underwent endoscopic marsupialization by a single surgeon (MJA) using a new technique involving a medial wall cruciate incision. Patients were followed up for a minimum of 6 months and analyzed for the resolution of dacryocele and intranasal cysts and anatomical and functional success. The mean age at presentation was 5.9 weeks with a female preponderance (71.4%). All patients presented with a subcutaneous swelling in lacrimal sac region. Acute dacryocystitis was noted in 42.8% (3/7). Associated lacrimal anomalies were noted in 28.5% (2/7), and associated respiratory distress was noted in 57.1% (4/7) of the patients. At a mean follow up of 10.8 months, anatomical patency and resolution of intranasal cyst were achieved in all cases, and functional success was noted in all except 1 patient. Endoscopic evaluation of all dacryoceles is recommended. Medial wall cruciate marsupialization is a safe and effective modality in the management of large intranasal cysts. Early diagnosis and appropriate quick referral are likely to prevent acute dacryocystitis, progression of dacryocele, and may aid in better outcomes.

Conservative Treatment Using Marsupialization for Cysts Occurring in the Jaw of Adolescents: A Case Report

Dentigerous cyst (DC) is an odontogenic cyst associated with the crown of an impacted, embedded, unerupted, or developing tooth. It is the second most common type of odontogenic cysts, accounting for 14% to 24% of all jaw cysts. Although these cysts occur more frequently during the second and third decades of life, they can also be found in children and adolescents in the mixed dentition stage. Treatment of the odontogenic cyst involves enucleation or marsupialization/decompression methods. The latter approach is preferred for larger cysts, and it is especially helpful in adolescent patients in conserving the unerupted permanent successors. The aim of treatment for DC is the complete elimination of pathology and maintenance of dentition with minimal surgical intervention. Recently defined criteria for the selection of treatment modality include the cyst size and location of the cyst, patient age, dentition involved, stage of root development, position of the tooth involved in the jaw, and relationship with the surrounding vital structure. Marsupialization or decompression technique has been advocated by several authors for treating DCs among young patients. In this conservative technique, the creation of an accessory cavity helps relieve intra-cystic pressure and accelerate the healing of cystic lesion. This technique has been successfully performed and is indicated for growing children and adolescents. Here, we report a large cyst lesion in the mandible treated by marsupialization for conservative management. In conclusion, successful reduction in size was achieved, and intraoperative complication could be prevented.

Flexible Carbon Dioxide Laser-Assisted Endoscopic Marsupialization and Ablation of a Laryngeal Saccular Cyst in a Neonate

To report the occurrence of a neonate with a lateral saccular cyst that was successfully managed by flexible, carbon dioxide laser-assisted endoscopic marsupialization and ablation. A full-term, 14-day-old girl presented to the clinic for progressively worsening stridor since birth. On fiber optic laryngoscopy, she was found to have a large, right saccular cyst obstructing the laryngeal inlet. The patient was admitted and underwent microlaryngeal endoscopic CO2 laser marsupialization and ablation of the saccular cyst. She was observed overnight and was discharged without complication the next day. At that time, stridor was no longer present and she remained symptom free at both her 2-week and 3-month follow-up. The congenital saccular cyst is a rare, abnormal dilation of the laryngeal saccule that is known to be a cause of airway obstruction. A variety of contrasting treatment strategies for laryngeal saccular cysts in children have been reported in the literature. Determining the definitive treatment modality thus remains a challenge that is compounded further by the rarity of the lesion. We introduce a new surgical technique that employs a 30-degree angled telescope with a flexible laser fiber system that provides excellent visualization of saccular cysts, in particular, lateral lesions that are less visible using line-of-sight technology.

Peripheral Adenomatoid Odontogenic Tumor Related to Dentigerous Cyst Marsupialization

This study reports an unusual case of a peripheral adenomatoid odontogenic tumor arising in a post-marsupialization site and its relationship to a dentigerous cyst. Boy, 14, was referred to treat swelling in the left anterior maxilla that was associated with impaction of teeth #22 and #23. Treatment planning included marsupialization and posterior orthodontic traction of the impacted teeth. The marsupialization reduced significantly the swelling after 4 months, but in the access site of the marsupialization a 3-cm wide sessile nodule developed at the vestibular gingiva.

Laparoendoscopic Single-Site Surgery in Urology Using Conventional Instruments: Our Initial Experience

To present our initial experience with laparoendoscopic single-site (LESS) urologic surgery using conventional laparoscopic instruments and to assess its feasibility and safety. In 20 patients, we performed LESS urologic surgery, which included simple nephrectomy in 9, nephroureterectomy in 1 for a refluxing nonfunctioning kidney, radical nephroureterectomy in 1, heminephroureterectomy in 1 for a nonfunctioning upper moiety in a complete duplex kidney, marsupialization of a renal cyst in 1, ureterolithotomy in 1, varicocelectomy in 2, pyeloplasty in 2, vesicovaginal fistula (VVF) repair in 1, and orchiopexy in 1. LESS was performed using a small periumbilical incision, inserting regular trocars, and using a conventional 30-degree laparoscope and laparoscopic instruments. Data were collected prospectively with respect to feasibility, intraoperative or postoperative complications, postoperative pain, analgesic requirement, and recovery. Since March, 2012, a total of 20 patients have undergone LESS for various urologic conditions. All cases were completed successfully, without conversion to a standard laparoscopic or open approach. The total operative time for the nephrectomy, nephroureterectomy, pyeloplasty, VVF repair, ureterolithomy, varicocelectomy, or orchiopexy was 134 ± 20.06, 186 ± 40, 135 ± 21, 180, 150, 55, and 60, minutes, respectively. The mean blood loss was 100 mL. No intraoperative complication occurred. The mean pain score on the visual analog scale was 8.35 ± 0.9 (8-10) on day 1, 4.8 ± 1.6 (2-8) on day 2, and 2 ± 1.2 (2-4) on day 3. Similarly, the mean analgesic requirement was 220 ± 41 mg, 85 ± 74 mg, and 30 ± 47 mg of intravenous tramadol, respectively. One patient had surgical emphysema of the abdomen and another had ileus for 4 days. The mean hospital stay was 2.9 ± 1.7 (2-7) days. In selected patients, LESS for urological indications using conventional laparoscopic instruments is safe and feasible with no added cost. Additional experience and continued investigation are warranted.

The endoscopic intraventricular management of pineal cysts: a minimally invasive modus operandi

The management of pineal cysts is still debatable, especially for asymptomatic incidental ones. For symptomatic cysts associated with hydrocephalus, the surgical management is mandatory and may include either classical microsurgical approaches to the pineal region or endoscopic trans-ventricular approaches in a minimally invasive philosophy. The authors expose a stepwise technique to treat a pineal cyst associated with an obstructive hydrocephalus in one procedure gathering a third ventriculostomy followed by an intraventricular marsupialisation of the pineal cyst. This endoscopic approach allows the treatment of the hydrocephalus and the pineal cyst in one short minimally invasive procedure.

A Single-Arm, Prospective Study of Laser-Assisted Marsupialization for Epiglottic Cysts in Adults

A Single-Arm, Prospective Study of Laser-Assisted Marsupialization for Epiglottic Cysts in Adults

Incidence of Bartholin duct cysts and abscesses in the Republic of Korea

ObjectiveTo estimate the incidence of Bartholin duct cysts and abscesses in the Republic of Korea during 2009. MethodsA national patient sample (n=599 186) was obtained from Korean Health Insurance Review and Assessment Service data and analyzed to estimate the incidence of Bartholin duct cysts and abscesses among Korean women in 2009. ResultsThere were 587 Bartholin duct cysts and 757 Bartholin duct abscesses during 2009. The total incidence of Bartholin duct cysts and abscesses was 0.55 per 1000 person-years and 0.95 per 1000 person-years, respectively. In women aged 35–50years, the incidence was 1.21 per 1000 person-years and 1.87 per 1000 person-years, respectively. In multivariate logistic regression analysis, the incidence of Bartholin duct cysts and abscesses was associated with age (P<0.01), but not with season or socioeconomic status, among women aged 15–50years. The main operation performed was marsupialization (45.2%) for Bartholin duct cysts and incision (71.5%) for Bartholin duct abscesses. ConclusionThe incidence of Bartholin duct cysts and abscesses increased with age until menopause, decreasing thereafter.

A dentigerous cyst containing an ectopic canine at the infra-orbital rim: a case report

This case report demonstrates the spontaneous eruption of a maxillary canine from the infra-orbital margin after marsupialization of a dentigerous cyst. Clinical Relevance: Dental practitioners should be aware of the presentation of dentigerous cysts, their possible effect on the position of associated teeth, and the indications for urgent referral of such cases. The need to examine radiographs carefully for ectopic teeth in unexpected positions should also be appreciated.

Congenital dacryocystocele: presentation and treatment

To report the presentation, complications, and treatment strategies for infants with congenital dacryocystocele. We performed a retrospective chart review of all patients presenting with dacryocystoceles to Beijing Children's Hospital between 2007 and 2011. Thirty-one patients (33 eyes) were identified, presenting at a median age of 10 days of life. Twenty-four (72.72%) patients presented with cellulitis or dacryocystitis and required systemic antibiotics. Two (6.45%) patients presented with respiratory compromise. Resolution occurred with conservative treatment for 6 eyes, but 27 (81.82%) required surgical intervention. All 27 eyes received probing, and 20 (74.07%) were successful. The other 7 eyes required marsupialization of an intranasal cyst. Although congenital dacryocystoceles may resolve with conservative measures, many become infected and require systemic antibiotic treatment, and most require surgical intervention. Referral in the early neonatal period can aid in timely intervention before complications such as infection occur.

Single-Incision Pediatric Endosurgery for Ovarian Pathology

Despite being pioneered by gynecologists, single-incision endosurgery has not been widely reported for the treatment of ovarian and adnexal pathology in neonates, children, and adolescents. We describe our initial experience using single-incision pediatric endosurgery (SIPES) for these indications and discuss advantages and drawbacks. All children who underwent SIPES with a preoperative diagnosis of ovarian or adnexal pathology were included in the study. Data on age, operative time, complications, length of hospital stay, and outcomes were collected. From January 2010 until January 2012, 19 girls (mean age, 11.4 years; range, 6 days-17 years; weight range, 4.0-90 kg) underwent SIPES procedures for ovarian or adnexal diagnoses, including hemorrhagic/follicular/paratubal cysts (n=8), torsion (n=7), tumor (n=3), and parauterine cyst (n=1). The operations included cyst unroofing (n=4), detorsion and oophoropexy (n=7), (salpingo)oophorectomy (n=5), marsupialization of cyst (n=2), and cyst aspiration (n=1). Median operative time was 42 ± 29 minutes; there were no conversions to conventional laparoscopy or open surgery. Fifteen patients (79%) were discharged within 24 hours after the procedure. There were no peri- or postoperative complications. Histopathology showed hemorrhagic/follicular/paratubal cyst (n=7), necrotic/calcified ovarian tissue after torsion (n=6), cystadenofibroma (n=1), granulosa cell tumor (n=1), and mature teratoma (Grade 0) (n=1). SIPES is an excellent alternative to conventional laparoscopy for the treatment of adnexal pathology. Using a single umbilical incision that can be enlarged instead of three smaller trocar sites facilitates the resection and extraction of ovarian masses without compromising cosmesis.

A review article on the diagnosis and treatment of cerebrospinal fluid fistulas and dural tears occurring during spinal surgery

Background:In spinal surgery, cerebrospinal fluid (CSF) fistulas attributed to deliberate dural opening (e.g., for tumors, shunts, marsupialization of cysts) or inadvertent/traumatic dural tears (DTs) need to be readily recognized, and appropriately treated.Methods:During spinal surgery, the dura may be deliberately opened to resect intradural lesions/tumors, to perform shunts, or to open/marsupialize cysts. DTs, however, may inadvertently occur during primary, but are seen more frequently during revision spinal surgery often attributed to epidural scarring. Other etiologies of CSF fistulas/DTs include; epidural steroid injections, and resection of ossification of the posterior longitudinal ligament (OPLL) or ossification of the yellow ligament (OYL). Whatever the etiology of CSF fistulas or DTs, they must be diagnosed utilizing radioisotope cisternography (RIC), magnetic resonance imaging (MRI), computed axial tomography (CT) studies, and expeditiously repaired.Results:DTs should be repaired utilizing interrupted 7-0 Gore-Tex (W.L. Gore and Associates Inc., Elkton, MD, USA) sutures, as the suture itself is larger than the needle; the larger suture occludes the dural puncture site. Closure may also include muscle patch grafts, dural patches/substitutes (bovine pericardium), microfibrillar collagen (Duragen: Integra Life Sciences Holdings Corporation, Plainsboro, NJ), and fibrin glues or dural sealants (Tisseel: Baxter Healthcare Corporation, Deerfield, IL, USA). Only rarely are lumbar drains and wound-peritoneal and/or lumboperitoneal shunts warranted.Conclusion:DTs or CSF fistulas attributed to primary/secondary spinal surgery, trauma, epidural injections, OPLL, OYL, and other factors, require timely diagnosis (MRI/CT/Cisternography), and appropriate reconstruction.

Appearance can be deceptive: Dentigerous cyst crossing the midline

Dentigerous cyst is a developmental odontogenic cyst, which develops by accumulation of fluid between reduced enamel epithelium and the tooth crown of an unerupted tooth. Dentigerous cysts are usually solitary, slow growing, asymptomatic lesions that are incidentally found during routine radiographs They most frequently involve the mandibular third molar followed in order of frequency by the maxillary canine, mandibular second pre-molar and maxillary third molar. Occasionally, these cysts become painful when infected causing swelling and erythema. The cyst is usually small, however, when large, results in the expansion and thinning of the cortex leading to pathological fracture. Radiographic features are specific to the lesion characterized by a well-defined radiolucency circumscribed by a sclerotic border, associated with the crown of an impacted or unerupted tooth. Dentigerous cysts are treated most commonly by enucleation, Marsupialization and decompression of cyst by fenestration. The criteria for selecting the treatment modality is based on the age, size, location, stage of root development, position of the involved tooth and relation of the lesion to the adjacent tooth and vital structure. The prognosis is an excellent when the cyst is enucleated and recurrence is rare. In this article, we present a case of a Dentigerous cyst in an 80-year-old man in the anterior aspect of the mandible enveloping an impacted canine and crossing the midline but with no clinical expansion or discomfort.

Esophageal Duplication Cyst, Successfully Treated Endoscopically: Case Report: Presidential Poster

Purpose: Esophageal duplication cysts are unusual congenital anomalies of the foregut. It can present with symptoms of chest pain, dysphagia, or dyspnea. Diagnosis is made with combined imaging modalities such as CT scan, and/or Endoscopic Ultrasound (EUS). Currently the standard of care includes surgical resection. As of today, less invasive procedures are on the verge of investigation. This is the case report of a 41 year-old male with a chief complaint of retrosternal chest pressure occurring after meals, and dysphagia to solid food. The patient was diagnosed with an esophageal intraluminal mass on CT scan. Upper endoscopy revealed an esophageal intraluminal bulge that was nearly obstructing the esophageal lumen starting at 30 cm from the incisor extending to 38 cm from the incisor. The EUS revealed an anechoic lesion originated from the muscularis propia layer consistent with duplication cyst. Giving that the patient was symptomatic, endoscopic cyst marsupialization was planned to achieve minimally invasive treatment compared to surgical resection. The anterior wall of the cyst was punctured using a 19-gauge needle (Cook, Winston Salem, NC). A 450 cm long 0.035 mm Guidewire (Boston Scientific Corp., Natick, MA, USA) was inserted through the 19-gauge needle followed by exchange of the EUS needle for a needle knife (Boston Scientific Corp., Natick, MA, USA) over the guidewire. 1 cm fenestration (marsupialization) was done in the anterior wall followed by insertion of the adult endoscope inside the cyst cavity for interrogation of the cyst wall. A successful longitudinal cut of the anterior cyst wall was done by needle knife and pallitome. The mucosa, submucosa and muscularis propia layer were cut achieving continuous communication between the cyst and esophageal lumen creating pseudodiverticulum. The procedure was done without complications. Follow-up with an upper endoscopy 2 months later showed cyst resolution. The patient had no further complaints of dysphagia or chest pain. Very few cases are reported in the current literature describing endoscopical resection of esophageal cyst. Endoscopic marsupialization of duplication cyst is a minimally invasive procedure, feasible, and a reasonable alternative to an open and invasive surgical approach.Figure: No Caption available.

Transoral power‐assisted marsupialization of vallecular cysts under local anesthesia

Transoral power‐assisted marsupialization of vallecular cysts under local anesthesia

Posterior spinal cord herniation: a novel occurrence following surgery for an intramedullary cyst at the thoracolumbar junction

Dorsal herniation of the spinal cord through the dura is an uncommon phenomenon and this is only the fifth reported case in the thoracolumbar spine, the first following surgery at the thoracolumbar junction. A 57-year-old male underwent marsupialisation of a benign intramedullary cyst at the T12-L1 level and subsequently returned with symptoms of dorsal column compromise. He was found to have a posterior herniation of the cord into a pseudomeningocele at the level of the previous surgery. The hernia was reduced surgically and the defect closed directly without the need for a dural patch leading to a full recovery. Posterior cord herniation, its possible aetiologies and management strategies are discussed.

Endoscopic Marsupialization of Maxillary Odontogenic Cysts

Objective: Management of maxillary odontogenic cysts consists of transoral resection or curettage. Large lesions require extensive dissection, leading to perioperative morbidity and need for extensive reconstruction. 1) Describe the use of transnasal endoscopic marsupialization for the management of maxillary odontogenic cysts. 2) Understanding this approach can minimize morbidity with effective treatment. Method: Case series. Endoscopic sinus surgical techniques were used to treat large benign maxillary odontogenic cysts in five patients between June 2008 and October 2011. Results: Patients underwent endoscopic marsupialization after creation of a wide maxillary antrostomy. Molars associated with the cystic lesions were displaced into portions of the maxillary sinus in 2 cases. The molars were dissected and removed through the transnasal dissection in each of these cases. Histological and radiological findings were consistent with 1 odontogenic keratocyst, 3 dentigerous cysts, and 1 radicular cyst. The lesions were able to be marsupialized endoscopically with relief of the patient’s initial symptoms and no recurrence. Follow-up has shown an excellent functional outcome in all cases. Conclusion: Benign maxillary odontogenic cysts can be effectively treated using transnasal endoscopic approaches. The techniques are less invasive and can reduce morbidity compared to transoral techniques.

Percutaneous intrarenal marsupialization of symptomatic peripelvic renal cysts: A single-centre experience in China

Objective.The aim of this study was to report the authors' experience with percutaneous intrarenal marsupialization of symptomatic peripelvic renal cysts. Material and methods. Thirty-one patients (16 male and 15 female, with a mean age of 49 years) with a peripelvic renal cyst associated with chronic flank or lumbar pain or urinary infection were selected for percutaneous intrarenal marsupialization with a 2 μm laser in the authors' centre from January 2005 to December 2010. Cyst size ranged from 4.5 to 10.5 (mean 6.0) cm. The cysts were punctured by a percutaneous technique guided by ultrasonography, a 20.8 F nephroscope was introduced and the whole internal surface of the cyst was inspected. Methylene blue was injected through the ureteral catheter to help identify the collecting system. A 1.5–4 cm incision was made at the avascular area of the cystic wall by the 2 μm laser to achieve intrarenal marsupialization of the cyst into the renal collecting system. One or two 6 F double-J stents were placed with the proximal end in the cyst for 2–3 months. Results.The mean operation time was 50 (25–120) min. No serious complications such as massive bleeding, urine leak or infected haematoma occurred. The patients were followed up for a mean of 12 (range 3–36) months. All patients were relieved of their symptoms. Eighteen cysts disappeared after surgery, while 13 cysts reduced in size by over one-third and communicated with the renal collecting system. No enlargement of cysts was observed. Conclusions.Percutaneous intrarenal marsupialization with a 2 μm laser is an effective and safe procedure and may offer a minimally invasive alternative for the management of symptomatic peripelvic renal cysts.

Tension Arachnoid Cyst Causing Uncal Herniation in a 60 Year Old: A Rare Presentation

Arachnoid cysts are congenital benign cysts accounting for approximately 1% of all intracranial mass lesions. Uncal herniation due to arachnoid cyst is a rare mode of presentation. It is hypothesized that only tension arachnoid cyst could cause the life-threatening condition that results from a progressive deterioration and worsening of a simple and usually congenital arachnoid cyst, associated with the formation of a "ball valve" at the point of an opening on the cyst wall. To-date only one case of an arachnoid cyst causing Uncal herniation has been reported to the best of our knowledge. We present a rare case of uncal herniation in a 60-year-old lady caused by a giant left temporal arachnoid cyst. She presented to us in emergency room after experiencing headaches since last one week followed by vomiting, seizures, and altered state of consciousness. She was operated immediately and marsupialization of the arachnoid cyst was performed. She showed good recovery. Although arachnoid cyst is a benign slowly growing pathology, it can lead to Uncal herniation as a "tension" arachnoid cyst, possible due to "ball-valve" mechanism. Elective treatment should be considered to prevent progressive significant enlargement of cyst.